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Weight Loss Surgery:
Finding the Thin Person Hiding Inside You.


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Issue #169

July 1, 2009

In This Issue


* An Alternative: Gastric Sleeve
* 911 – I Need Help and I Weigh More Than 350 Pounds
* Cosmetic Surgery, Some Points to Consider
* Recipe: Creamy Fruit Squares
* Success Story: Life, Liberty and the Pursuit of Happiness by Julie Dostal

An Alternative:
  Gastric Sleeve

Last week I attended the annual meeting of the American Society for Metabolic and Bariatric Surgery.  This is the professional association for your surgeon and all of the staff in the practice including bariatric coordinators, nurses, psychologists, and dieticians.

Every year at the meeting there seemed to always be a hot topic. This year the topic was the gastric sleeve. Everyone seems to be talking about it. The sleeve is not yet covered by insurance, but probably will be soon. There is less risk of complications with the sleeve, as opposed to the gastric bypass, because the intestines are not rerouted.  There is not a problem of a stoma stretching because a stoma doesn’t have to be created.  The pyloric valve at the base of the stomach still functions.

During the procedure, the surgeon removes about 60% of the stomach so that it takes the shape of a tube or sleeve. Because the stomach is actually removed, the surgery is not reversible.

Bariatric practices report that the results look very good. Patients tend to lose more weight than with the lap band, but less weight than with the gastric bypass.  The cost for having a gastric sleeve will compare with the gastric bypass. The lap band is the least expensive to have, so those without insurance won’t have an alternative to the lap band when considering cost.

Weight loss surgery is about choices – choices to have or not have surgery and choices on what kind of surgery to have. It seems the debate will continue on what the best surgery is, but that is a very individual decision best decided between the patient and the surgeon.

Click here for more information regarding the disadvantages of,
advantages of, and eating after a gastric sleeve.

911 – I Need Help
  and I Weigh More Than 350 Pounds

A story appeared on Monday regarding an ambulance company that wants to raise their charges for obese patients. The cost will go from $629 to $1,172. There are so many things wrong with this that it is hard to know where to start.

Here is the article

First of all, how will the ambulance company know which ambulance to send, the “regular” one or the one equipped for large patients. Will they ask on the phone how much the patient weighs?

Will other people who are not obese use the ambulance or will they save it just for the obese patients? If the ambulance company uses it for others, why would just the obese patients be charged?

The cots hold up to 500 pounds, but they would charge patients who are 350 pounds and up and may even charge patients who are 275 pounds.

The obese and especially the morbidly obese are such easy targets.  And I must point out that the only group out there pointing out inequitable treatment and fighting for access to care for all categories of obesity is the Obesity Action Coalition. The OAC is our voice and to be a strong voice, we need your support.  Please join the OAC today. Go to and click on Membership in the navigation bar.

Summer is here! Get Back on Track!


Back on Track with Barbara

Internet Mentoring Program

Are you...

Suffering from emotional eating and can’t stop?
Grazing on carbohydrates and can’t control it?
Lacking inspiration to lose the weight you have regained?
Feel you don’t know what to do now that you have had surgery?
Dying to be in better shape for Summer?

 Then you are in luck! My Back on Track Internet
Mentoring Program is just what you need!


View a FREE Lesson and Listen to a FREE Telephone Seminar by
clicking here and scrolling down to the bottom of the page.

Cosmetic Surgery
  Some Points to Consider

Dear Barbara,
Can you tell me, if since your surgery in 2000, have you found it necessary to have cosmetic surgery?

Hi Ellen,
Actually I did have some plastic surgery, but only on my face.  The picture above is right after my surgery.  I found that after losing my weight, my face was sagging so badly that I looked unhappy all the time. I wanted to look as happy on the outside as I felt on the inside. So I had plastic surgery.

I haven’t had anything else done, mostly because of fear of the pain.  I am such a wimp and I have a very low threshold for pain. But there are some very specific things that you need to bear in mind if you are looking to have plastic surgery.

First of all, plastic surgery is rarely covered by insurance. Even if it is medically necessary, such as the excess skin causing skin rash and infections, insurance companies are extremely reluctant to pay.

Be sure to have a plastic surgeon that has worked on weight loss surgery patients. Cosmetic surgery done by “nip and tuck” plastic surgeons is far different than reconstructive surgery that many people require in which many pounds of skin are removed.

For more information about plastic surgery, get my CD that will explain all about it. You can get more information about my CD at .

  Creamy Fruit Squares
Creamy Fruit Squares

1 ½ cups boiling water
1 pkg. (8 serving size) strawberry sugar-free Jello
1 can (20 oz.) pineapple chunks in juice, undrained
Ice cubes
1 tub (8 oz) Cool Whip Free, thawed, divided

Stir boiling water into Jello in a large bowl at least 2 minutes until completely dissolved. Drain pineapple reserving the juice. Add enough ice to juice to measure 1 ½ cups. Add to Jell-O and stir until ice is completely melted. Refrigerate about 45 minutes or until slightly thickened. Remove 1 ½ cups of the gelatin and stir in the pineapple.

Add ½ of the whipped topping to the remaining Jello. Stir with a wire whisk until well blended. Pour into a 9-inch square dish. Refrigerate about 15 minutes until set but not firm. Carefully spoon fruited Jello over creamy layer in dish.

Refrigerate at least 3 hours or until firm. Cut into squares. Serve topped with remaining whipped topping. Serves 8

Each Serving:
80 calories, 19 grams carbohydrate, 2 grams protein

If you have a recipe that you would like to share in future issues of this newsletter, please send it to me at

Success Story:
  Julie Dostal

I want to offer a special thanks to Julie Dostal for sharing her story with us that is just perfect for the 4th of July holiday. Here is her story:

Dear Barbara,
I am 4 years post-op with a lap band and am maintaining a 150 lb weight loss.  My highest BMI was in the 50's and today it is 27.  Life has changed significantly.  In thinking about the upcoming holiday, I wrote a piece about the freedoms that come along with weight loss surgery.  I wanted to share it with you and with your readership.  It is long, I am aware.  But, I wanted to take a chance that it may speak in a powerful way.


Life, Liberty and the Pursuit of Happiness-

“We hold these truths to be self-evident, that all men are created equal, that they are endowed, by their Creator, with certain unalienable Rights, that among these are Life, Liberty, and the pursuit of Happiness.”

The themes of independence and liberty have come up a lot for me recently.  I have been philosophical in thinking about how the preamble to the Declaration of Independence applies to my life after weight loss surgery.  As I read the preamble, several phrases and words jump out at me.  To me, it is as if Thomas Jefferson knew that his words could have a very broad application and wrote them in way to make them accessible to more than just the members of the Continental Congress. It is as if he wrote the words to be universal in their appeal and transcendent in their meanings.

Truths that are self-evident; meaning truths that are obvious, truths that require no proof or explanation… they just “are.”  We are all created equal; we are endowed with certain fundamental rights by our Creator; we are endowed with life, with liberty, and the right to pursue happiness.

“Truth”   Truth is a powerful word.  And in the writing of this preamble, the author infused this simple word with even greater value by indentifying these truths to be self-evident.  Every truth that follows this very first thought of his phrase requires no proof because he is assured that it is in the very nature of The Creator that they be true.

As an obese woman, the notion that I was created as an equal to all others on this earth was foreign to me.  I always felt unequal.  In fact, I was often treated unequal.  This is one of the driving forces behind my over achieving ways.  It seemed to me that I was required to perform “above and beyond” in order to merely play in the same league as thin people.  Because society identified me as a “less than” person, I knew I was starting with a deficit that had to be overcome (and then some) in order to be perceived as equal.

In this instance, weight loss surgery has given me two things.  First, and probably most importantly, I have come to see myself as equal.  I no longer perceive that I must begin far behind the start/finish line where all of the rest of the world is standing. I no longer identify my own self as a “less than” person simply because I have the disease of morbid obesity.  I have a disease.  I did not cause it.  It did not seek me out because I was some sort of a deficient human being.  Therefore, like all others, I am created equal. Created.  Equality was always inherently mine, endowed by my Creator, I just didn’t know it.   Second, I am now treated as an equal.  Those who would be prejudice now have no physical basis upon which to hang their judgments. It is a sad fact of our society, yet it is nevertheless true.  I am treated more nicely, with greater respect, and with less scrutiny than I was as an overtly obese woman. 

We are endowed with life.  My life is forever changed by weight loss surgery.  I believe that my surgery has endowed me with additional life, longer life, and far greater quality of life.  Before weight loss surgery, I was looking down the barrel of a loaded musket of co-morbidities.  My genetics had already loaded the gun with high blood pressure, diabetes, cancer, and heart disease.  My obesity had essentially cocked the gun, and my own behavior was shoving gun powder into the muzzle as fast as possible.  Now that I am a normal size, I have managed to significantly reduce the risk of that disaster-in-waiting.  It was a pretty sure shot that life as a senior adult was not going to be of high quality.  It was plausible that life could have gotten pretty bad, pretty quickly.  Weight loss surgery has managed to uncock the gun and has helped me unload some of that gun powder.  The bullets are still in the chamber.  I can’t change that because my genetics are my genetics.  However, I’m no longer pointing the gun at my own head.

I am endowed with life.  I intend to live my life to its fullest. 

Liberty is another one of those unalienable rights given to us by our Creator.  I had no idea how significantly my liberty was impacted by my obesity.  I was literally captive in my own body.  There were so many things that I couldn’t or wouldn’t do because I was either too large to do them comfortably or I felt too embarrassed.  I had conveniently made up great excuses that downplayed my inabilities to do certain tasks. 

My best word to express the way I feel about my post-operative life as it relates to liberty is “unshackled.”  I absolutely feel as if someone found the key to my handcuffs and leg irons and let me go. I am no longer walking around dragging 150 pounds of prison with me.  To be unshackled is to experience absolute freedom.  It is a kind of freedom that is enjoyed only by people who know what it is like to be “unfree.”  Those who have always had their freedom cannot possibly imagine the unspeakable joy that is associated with being released. 

I am able to move my body in ways that I never imagined to be possible.  I am always looking for new ways to move and new ways to express my body’s liberty from the ravages of a horrible, chronic disease. I am often like a two-year old who giggles in delight at each discovery of a previously unknown ability.  This liberty is priceless and makes me deeply grateful to The Creator for the weight loss surgery that set me free.

I am also grateful for the right to pursue happiness.  I am keenly aware that The Creator did not give me the right to immediate happiness; He gave me the right to pursue it.  Weight loss surgery has given me a new opportunity to pursue true joy in life on a variety of levels.   Some of my seeking brings me to things completely and utterly on the surface.  They are the transient things that do not have eternal value; reveling in new clothing, getting new hair styles, and wearing high heels.  However, most of my pursuit is on a much deeper, soul level.   

I have shed the physical layers that were so much a source of pain, shame, and a feeling of complete and utter failure. Having shed those layers, I find (much to my surprise) that happiness is still something that I have to pursue.  I was mistaken to think that my pursuit of happiness was the weight loss alone.  I thought surely thinness would equal happiness.  It does not.  The physical part of me that is left after the weight loss is merely the foundation for pursuit of happiness.  The new life that I have been given, along with the liberty that frees me are the building blocks of this third, but ever-so-important inalienable right.  It is the only listed inalienable right that contains a verb, it is the only inalienable right that required something of me from the moment I receive it. 

Each day is a new opportunity to pursue happiness. I find that achieving happiness is much more about me than about my achievements or situations.  It has become clear that living an event-driven life does not produce lasting happiness.  If I am waiting for an event to make me happy, then I have missed the point.  I can no longer allow myself to fall into the trap of “I’ll be happy when this happens or when that happens.”  That is transient.  Lasting happiness is my responsibility, through a connection with The Creator. 

I am sure that Thomas Jefferson was aware how significant the Declaration of Independence was and that it would take its place in the history of a nation.  Yet, I don’t believe that he could have possibly known that he was writing the Preamble to the Declaration of Independence for one woman who would draw strength from it more than 200 years later. 

So, I close with this thought; Thomas Jefferson may not have known that he was writing to me.  However, I am sure that The Creator was well aware, even in 1776, that this preamble would give me pause to take a few moments out of a busy week to acknowledge His presence, His gifts, and the truths about Him that are self-evident. I am sure that The Creator knew that I needed to stop and look at all He has given me through this miraculous process called weight loss surgery; equality, life, liberty and the pursuit of happiness; precious gifts that are only endowed by a loving Creator.  For these, I am eternally grateful.  For these I thank the Creator who created me.

Julia Dostal

Julia M. Dostal, PhD
Executive Director
LEAF Council on Alcoholism and Addictions
Oneonta, NY 13820

Congratulations Julia


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